HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE I O M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RE E.
L�r
r.
�■► - tv,Aw. E2
_ Building Permit Applicat1$
Planning and Development Services
Building and Code Regulation Division rtmen
2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial ResitYr FL
PERMIT APPLICATION FOR:
PRQPORE D INPRKUNY4
Address: W7el" /(/Pfz, vc61/
.Legal Description: iY/G�i
Property Tax ID#: Ai Pow— aayY Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
� ETA'LED DE�S�R�(�PTlQN + �W4
Me M Y
J�C*M�TRUCTISU'11Nlfi", ION:
Additional work to be performed under this permit-check all that appy;
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
—Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction:. S-d d7 • Sq. Ft. of First Floor:
Cost of Construction:$��/60 19 Utilities: _Sewer _Septic Building Height:
OVI( ER/lE=�SSEE: CCINTR
Name ! !� Name:
Address: 7G c5- ,"eh RAet- Company:
City: /Appm State:_ Address:
Zip Code: Fax: City: State:
Phone No. / Zip Code: Fax:
. E-Mail: Phone No
Fill in fee simple Title older on next page(if different E-Mail
from the Owner listed above) State or County License
it value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S ,PPL�MENTAt,r0s- NSTRl1� � A �,NI�IAW N'��RMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize thepermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full,concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID paz�
STATE OF FLORIDA
COUNTY OFCOUNTY OF
The forgoing instru nt was acknowledgef The forgoing instrument was acknowledged before me
thi day of 20 6ythis day of 20by
D� ;eI � �`e Name of person making statement. Name of person making statement.
_
C 6) J
Personal) n OR Produced Identifli�W Personally Known OR Produced Identification
Type of I n� io Type of Identification
Produced Produced
(Signature of No ry Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 812117